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NPI Code Detail

MEDICARE: JILL ANDERSON

MEDICARE: JILL ANDERSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12279P3900XNeonatal/Pediatric Registered Respiratory Therapist1143MN
22279P3900XNeonatal/Pediatric Registered Respiratory Therapist2956WI

General Provider Information

NPI Number : 1942342423
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL ANDERSON
Provider Business Mailing Address
First Line : 49746 THISTLE DR
Second Line :
City : BEMIDJI
State : MN
Zip : 56601-6744
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2800 CLEVELAND AVE N
Second Line :
City : ROSEVILLE
State : MN
Zip : 55113-1126
Country : US
Telephone Number : 651-642-1825
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2007
Last Update Date : 07/08/2007

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